VHA National Pain Management Strategy: Stepped care model implementation Robert D. Kerns, Ph.D. National Program Director Robert D. Kerns, Ph.D. National Program Director

Overview and objectives Agenda - Updates from VACO and Coordinating Committee - Gallagher – Pain Management Directive - Kerns – Performance measurement - Mariano – Primary Care Rural Health Initiative - Norton/Clark – Tampa Externship - Goodman – Opioid therapy: Practice and policy - Rashad – Nursing initiatives - Mariano – Patient education: MyHealtheVet - Implementation of the stepped pain care model - VISN presentations - Open discussion of barriers and facilitators Agenda - Updates from VACO and Coordinating Committee - Gallagher – Pain Management Directive - Kerns – Performance measurement - Mariano – Primary Care Rural Health Initiative - Norton/Clark – Tampa Externship - Goodman – Opioid therapy: Practice and policy - Rashad – Nursing initiatives - Mariano – Patient education: MyHealtheVet - Implementation of the stepped pain care model - VISN presentations - Open discussion of barriers and facilitators

Performance Metrics: Report to Congress HAIG Pain Management Survey HCAHPS - Patient Satisfaction Pain clinic MD staffing and workload Other possible measures HAIG Pain Management Survey HCAHPS - Patient Satisfaction Pain clinic MD staffing and workload Other possible measures

Health Analysis and Information Group (HAIG) Pain Management Survey TAG: Kerns, Cremo, Gallagher, Anderson, Nilan Single respondent per facility - Ideal respondent is Facility/HCS Pain POC Distribution on October 5 Content: - Adherence to Pain Management Directive - Organizational structure - Pain services and staffing - Opioid safety practices - Implementation of stepped care model - Staff education programs - Patient education programs TAG: Kerns, Cremo, Gallagher, Anderson, Nilan Single respondent per facility - Ideal respondent is Facility/HCS Pain POC Distribution on October 5 Content: - Adherence to Pain Management Directive - Organizational structure - Pain services and staffing - Opioid safety practices - Implementation of stepped care model - Staff education programs - Patient education programs

Patient satisfaction: HCAHPS* (Oct 08-May 09) National VISNs VAMCs Benchmark Score Min Max Min Max Composite Q Q Q13: During this hospital stay, how often was your pain well controlled? Q14: During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? Respondent N: 23,270 Percent of respondents designating “usually” or “always”. Adjusted for number of respondents in each sample * Consumer Assessment of Healthcare Providers and Systems National VISNs VAMCs Benchmark Score Min Max Min Max Composite Q Q Q13: During this hospital stay, how often was your pain well controlled? Q14: During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? Respondent N: 23,270 Percent of respondents designating “usually” or “always”. Adjusted for number of respondents in each sample * Consumer Assessment of Healthcare Providers and Systems

Pain clinic workload and MD staffing FY07FY08FY09 YTD Encounters48,26455,19048,805 Unique Pts20,86023,80623,824 MD FTE FY07FY08FY09 YTD Encounters48,26455,19048,805 Unique Pts20,86023,80623,824 MD FTE

Other performance metrics Joint Commission survey results LMS/TEMPO provider education MyHealtheVet access Timeliness of pain clinic access Cancer quality indicators Opioid safety practices Joint Commission survey results LMS/TEMPO provider education MyHealtheVet access Timeliness of pain clinic access Cancer quality indicators Opioid safety practices